L&T: RxPertise

Feb2011

Combating Senior-Eyetis

Eric Clapton as an eyewear icon pictured on his most recent CD. Photographed by Terry O’Neil.

By Carole Burns, OD

Eye disease increases exponentially with age. Conditions common to patients over age 65 include dry eye, cataracts and macular degeneration.

Starting in 2011, eyecare professionals are going to see a sharp and steady rise in the incidence of eye disease among baby boomers, the leading edge of whom turn 65 this year. According to agingstatistics.gov, in 2030, the older population is projected to be twice as large as in 2000, growing from 35 million to 71.5 million.

Eye doctors routinely treat these patients medically, but often overlook their optical needs. In order to treat all of the patient’s needs, eyecare practitioners have an obligation to understand the conditions of aging and to prescribe lenses which protect and maximize eyesight.

TREATING DRY EYEDry eye is found more frequently in females and increases with age, affecting up to 20 percent of the aging population. Current understanding about dry eye has increased significantly. The new understanding has led to a renaming of the condition: ocular surface disease (OSD).

A case presentation for patients with OSD should address three areas: medical treatment, environmental management and optical prescription. This three-part, global treatment plan provides the best care for the patient.

Consider the case of Mr. Jones, a 68-year-old gentleman suffering with OSD. Mr. Jones has moderate ocular surface disease. He is experiencing blurred vision, burning, itchy and stinging eyes. He is light sensitive and his eyes tear. The excessive tearing is worse in sunlight. He is being managed medically. In addition to his medical management, Mr. Jones should be given the following environmental and optical care. Below is an example of a case consultation with this patient.

“Mr. Jones, when people read, they tend to stare at the page. This causes a decrease in your blink rate. I noticed you have an e-reader. When reading, you need to occasionally think about blinking. I want you to look up and blink every time you move the screen, then look down and continue reading.

“In the winter, the dry heat makes your symptoms worse. It’s important to have a humidifier to help keep your eyes comfortable.

“To help you see better and feel better, I’m prescribing indoor glasses and outdoor glasses for you.

“Your sight outside is worsened by the scatter of light and by glare. You will need a brown outdoor tint to decrease the scatter. You may have heard on TV how blueblockers help you to see, this is because blue light scatters and it is blocked by brown filters. In addition to the brown tint, you must have polarized lenses to decrease the glare. Glare can become so severe that it may decrease your reaction time while driving—polarized lenses make all the difference. I want you to be sure your outdoor lenses wrap around your face, this helps keep the wind from causing more dryness.

“Mr. Jones, for your indoor eyewear you need to give yourself every advantage to improve your sight, so I am going to prescribe glasses with a light amber tint. I’m also going to prescribe a specific type of lens that will allow you to see well at distance and near, these lenses help by eliminating what we call ‘higher order aberrations.’

“Your indoor lenses need to be glare-free. Glare-free lenses allow more light into your eyes so it will also reduce halos around car headlights while driving at night. I’m going to prescribe the glare-free lenses for both your indoor and outdoor glasses.”
TREATING PATIENTS WITH CATARACTSAccording to the Centers for Disease Control, an estimated 20.5 million Americans over 40 have cataracts. This number is estimated to increase to 30.1 million by 2020.

Cataracts are a condition of aging and will affect each one of us. This insidious condition can be tolerated for quite a while by some but will eventually require surgery.

A case presentation for patients with cataracts should not concentrate on the eventual surgery, but should concentrate on treatment for the here and now. Since cataracts progress slowly, discussing environmental management and optical prescription are crucial.

Mrs. Green, a 59-year-old female has cataracts which are best corrected to 20/20 each eye. Mrs. Green is experiencing glare and blurred vision, especially at night. Car headlights seem like halos. She states that she is constantly feeling as if her glasses need to be cleaned, however cleaning never helps. Glare testing shows only a mild decrease in acuity. A case presentation follows.

“Mrs. Green, beginning cataracts are annoying, however we have many options that will help you. Cataracts decrease the amount of light which enters your eye. This means that to improve your sight, you must increase the amount of light. When reading, be sure to have a lamp positioned directly on your reading material. Halogen bulbs will light the room and help you to read.

“In addition, you will need both outdoor and indoor eyewear. You are experiencing the most common concern of patients with developing cataracts—glare. Your outdoor eyewear will need to be an amber shade, if you go with gray or another dark shade of lenses, you will be unhappy as everything will appear too dark. Your sunwear must be polarized, and there should be a glare coating on the front and back surface of the lenses. These two features—the polarization and the glare-free coatings—will decrease the glare, and the ultraviolet protection will stop the sunlight from hastening the cataract development. You should always wear these protective sun lenses when outdoors, even on cloudy days.

“Your indoor eyewear often seems dirty because less light is getting through the cataract and into your eyes. Putting an anti-glare coating on your indoor eyewear will allow 10 percent more light to enter your eye, helping you to see better. Glare-free lenses also reduce halos around car headlights while driving at night. In addition to the glare-free lenses, I am also going to prescribe a specific type of lens that will allow you to see well at distance and near. These lenses help by eliminating what we call ‘higher order aberrations.’”
TREATING PATIENTS WITH MACULAR DEGENERATIONAge-related macular degeneration, often called AMD or ARMD, is the leading cause of vision loss and even blindness among Americans age 65 and older. A new case of macular degeneration is diagnosed every three minutes in the U.S. It occurs in about 10 percent of people over the age of 50, and about 33 percent of people over 75.

AMD is most common in Caucasians of European decent and is more prevalent in women. Every year 1.2 million people with macular degeneration lose part of their central vision, and 200,000 suffer complete loss of central vision in one or both eyes. Prevent Blindness America and NEI warn that the number of Americans with age-related eye disease will likely double within the next three decades.

The consequences of macular degeneration are serious, not only for its victims and their quality of life but also for Medicare and other government services presently unprepared for the macro-level effects of AMD, at which experts warn will reach “epidemic proportions.”

AMD causes daily tasks that are part of central vision, such as driving and reading, to become difficult to perform. AMD is a disease affecting the central part of the retina and is the leading cause of vision loss in the developed world.

It has been shown that visible blue light may cause the highest risk for development or progression of AMD. Implantation of lenses during cataract surgery that do not filter blue light have been shown to increase the risk for development or progression of AMD.

Consider Mr. Smith, a 69-year-old retired business man who likes to spend time outdoors. He has no complaints about his vision. During testing you see macular drusen, photo document the macular areas and then show Mr. Smith the photos to discuss the clinical signs of macular degeneration.

“Mr. Smith, these yellowish dots are called macular drusen. These dots are not currently affecting your vision. However there are studies which show that blue light may make your macular degeneration progress which may cause permanent vision loss. To reduce your risk, I am prescribing outdoor and indoor eyewear.”

Transitions Offers Bilingual Diagnosis Guide for Age-Related Diseases

Transitions Optical offers a bilingual diagnosis guide which provides a comprehensive overview of several age-related diseases, including cataracts, AMD and glaucoma. The company also offers six disease cards that are intended to heighten patients’ understanding and help ease their anxiety during an eye disease diagnosis. Each includes a section on vision wear considerations to help maximize and protect vision, such as photochromics and anti-reflective coatings to protect against UV and counter light sensitivity and contrast issues.

Take-home PDFs of the various diseases, in English and Spanish, are available for download under the Marketing Tools/Multicultural section at
transitions.com/pro. In addition,the white paper “The Eye Disease Diagnosis: Addressing Communication Challenges,” is available on the site under the Education/Clinical Papers tab and may be of particular interest to eyecare professionals with an older patient base.

THE BENEFITS OF OUTDOOR AND INDOOR LENSESBe sure to point out the following benefits of outdoor lenses to Mr. Smith:

Protection against blue light

Protection against UV light

No glare lenses

Wrap sunglasses

High-definition lenses

Lenses that let you see at all distances

Describe these benefits to him by first noting that outdoor eyewear must protect against blue light, since prolonged exposure to blue light may cause macular degeneration to progress. Explain that his lenses will contain a 30 percent transmission amber tint. This tint filters out the harmful blue rays and, therefore, protects his eyes.

Then tell Mr. Smith, “To eliminate glare, your sunwear must be polarized and have a glare-free coating on the back surface. One study has shown that harmful glare contributes to 30 percent of left-hand turn accidents.”

When discussing the benefits of wrap sunglasses, point out to Mr. Smith that his sunlenses must wrap and sit very close to his face. This ensures that ultraviolet light does not damage the eye and the structures that surround the eye including his eyelids, sclera and conjunctiva. Because he will need impact resistant lenses, his glasses will also have ultraviolet protection built into the lenses. These lenses are lightweight, thin as well as protective.

You should also note, “To see the clearest, the best lenses today are aberration-free lenses. That’s why I am prescribing these high-definition lenses for you.

“Additionally, clearest vision is obtained with a lens that lets you see at all distances. We call these lenses progressive, and we will put you in the newest technology.

“Your indoor lenses will be high definition also to improve your sight. Your lenses must be glare-free and made of an impact resistant material called Trivex. This will not only protect your eyes in case of an accident as it is shatter resistant, but it is also safer as it comes with ultraviolet protection built into the lens.”

Notice in all three examples, it is assumed each patient must have at least two pairs of eyewear. In addition, many of these patients may also require computer lenses or specific lenses for reading, especially if some vision is already lost.

When prescribing what the patient needs, it is helpful to have a prescription pad pre-printed with all the features necessary for best sight which is handed to the patient as you are discussing their treatment plan. These pre-printed prescription pads give reality and let the patient know this prescription is just as important as every other medical prescription. ■

Dr. Burns is CEO and senior partner of a nine-doctor, three-location private practice and is co-editor of
ReviewofOptometricBusiness.com, a new, online practice management magazine. She has been named the visiting Benedict practice management professor for the University of Houston in 2011. She lives in Westerville, Ohio.